The Indiana Department of Mental Health, in cooperation with five Community Mental Health Centers (CMHCS) serving rural catchment areas and Indiana University-Purdue University at Indianapolis, proposes to evaluate the efficacy of new assertive community treatment (ACT) teams at four CMHCs. Each site will have both an experimental condition that will receive the ACT services plus existing CMHC services, and a control condition that will be eligible to receive all the services of the CMHC except ACT. A fifth CMHC will be used to evaluate experimentally an alternative case manager approach, the Rhinelander model. This fifth site will also provide nonexperimental comparisons between the ACT and the Rhinelander approach. The narrow focus of the proposed project is to evaluate the efficacy of rural case management services. There is a large gap in research on rural programs compared to ones in more populated areas. The broader focus is to embed this study within the matrix of a program of research on the ACT model. The focus of the evaluation will be: (1) client outcomes, such as reduced hospitalization, increased quality of life, improved role functioning, greater residential and financial stability, medication compliance, involvement with the legal system; (2) case management services in terms of frequency, duration, and types of contacts, and (3) cost-benefit analysis, including use of CMHC services, hospital use, case management services, and legal system involvement.